Experience with Non-survivors of Acute Carbon Monoxide Intoxication Who Received Hyperbaric Oxygen Therapy and Literature Review

Abstract

Purpose: The main purpose of this study was to determine the reason for the carbon monoxide (CO) poisoning-related deaths at out hospital and to describe the demographic data and epidemiology. Methods: We retrospectively selected this group of acute CO intoxication patients that received emergency hyperbaric oxygen therapy (HBOT) from April 2000 to August 2005 at our hospital. Data regarding age, gender, duration of CO poisoning exposure, cause of the episode, underlying disease, number of HBOT courses, hospital course, cormorbidity, and cause of mortality were obtained from the medical records. We also reviewed the admission data records, including vital signs, Glasgow Coma Scale, arterial blood gas, carboxyhemoglobin level, and intubation or not. Results: One hundred thirty-seven patients and 5 fatalities related to CO poisoning were reviewed; the mortality rate was 3.65%. The 5 fatalities were all male, in the prime of life (27~37 years old), and without major underlying disease. Four (4/5) patients committed suicide by inhaling CO from burning charcoal. They all received emergent HBOT. Prolonged unconsciousness was noted after series HBOT in 4 (4/5) patients. Four (4/5) patients developed rhabdomyolysis and acute renal failure. The causes of death were multiple organ failure (3/5, 60%) and septic shock (2/5, 40%). Conclusions: The causes of acute CO poisoning among the fatalities were suicide by inhaling CO from burning charcoal (4/5, 80%) and a fire accident (1/5, 20%) at our hospital. They were in the prime of life without major underlying disease. The brain is an oxygendependent organ, and the damage may be severe and irreversible after CO intoxication and hypoxia. Rhabdomyolysis and acute renal failure may also occur. Secondary infection and septic shock may worsen the already poor condition. The cause of death may be considered as multiple organ failure, including the brain, lung, and kidney.